PREFACE

Dr Irene  Odotei

The  Institute  of  African  Studies  has partnerships  and  collaborative  arrangements  with  many  other
University departments  and Schools. It has for some time  been working  together with the School  of
Public Health to forge  a  fruitful  partnership addressing health related  issues. In June the Institute and
the  School  collaborated  to  hold  a  seminar  with  support  from  UNFPA  on  the  broad  theme  Socio
Cultural  Dimensions  of  Reproductive  Health  and  Human  Development.  The  major  purpose  of
the  seminar  was  to promote  fruitful  discussions  between  staff  and  graduate  students  in  health  and
social  sciences,  which  we  hope  will  provide  a  basis  for  further  meaningful  collaboration  and
cooperation  in  future  in both  teaching and research.  The seminar  papers dealt  with  interdisciplinary
approaches  to  health  and  human  development  issues  which  are  currently  very  high  on  the  national
agenda  and  are admitted  to be inextricably  intertwined  with beliefs  and  behaviour  patterns  of the
people.  These  included  the directions  and  speed  of  spread  of sexually  transmitted  disease  &  death
(HIV/AIDS),  the  problems  of  socializing  the young  for  a  healthy  and  productive  adulthood  (FLE),
under  nutrition,  abortion  and  the  sad persistence  of unacceptably  high  levels  of  maternal  morbidity
and mortality.

The seminar  was  held at a time  in Ghana's  history  when  the power  of Northern  trained  medical
practice to treat  sickness  and  ward  off  disease  remains weakened  by  lack  of  material  resources  and
the  drains  on  human  resources,  which  have  led  to  half  or  more  of  locally  trained  health  personnel
operating abroad or in other jobs rather than in the  health  service  in Ghana. It is thus not  surprising
that  an  increasing  volume  of  health  seeking  behaviour  in  this  country  is  occurring  in  religious
contexts  and  that  the  influence  of  spiritual  and  traditional  healing  could  be  argued  to  be  in  the
ascendancy.  At  the  heart  of  the  matter  is  the  fact  that  culture  in  Ghana,  as  elsewhere,  profoundly
shapes  and  moulds  the  perceptions,  aspirations,  beliefs  and  practices  which  affect  health  and  well
being  and the behaviour  of the sick  and their  caretakers  Ii has accordingly  long  been  realized  that
cultural specialists are needed  in the study of health and health  seeking  behaviour.

Anthropology  and Public Health

Heggenhougen  and  Pedersen  (1997)  in  their  chapter  in  the  Oxford  Textbook  of  Public  Health
have  succinctly  outlined  the growing part played  by considerations  of culture  and  anthropology  and
anthropologists in public health.As they stress,

the partial or  total  failure  of scores of public  health  interventions  can  be  linked  to the  lack
of an  understanding  of and attention  to meaning  and to the wider  socio-cultural  context  of
peoples lives.

Granted  that works published  in the fifties  and sixties had underscored  the relevance  to health of
socio-cultural  issues, they note that  it was in the mid eighties that the relevance  of anthropology  and
the use of ethnographic  methods  for understanding and helping to solve public health problems were
readily  recognized.  They  thus argue  that despite the growth  of social  epidemiology  from  the  middle
of the century and the Alma Atta Declaration on Primary Health Care in  1978, the new public  health,
which  takes on board  the multidimensionality  of health  issues and the need  for ethnographic  as  well
as medical approaches, is a more recent phenomenon.

As  they  note,  Public  Health  in  the  context  of globalization  and  the  virtual  collapse  of  state  and
public  medical  services  and dismantling  of welfare  states is, like much  else, in a state of deep crisis.

They  describe  the  way  in  which  a  sanitary  model  of  public  health  gave  way  mid  century  to  a
biomedical model, which in turn in the seventies evolved  into an ecological  model  encompassing  the
natural environment.  This in turn paved the way  for the  transition  to a socio-epidemiological  model
prevailing  at the end of the old millenium. It is the thesis of Heggenhaugen  and  Pedersen  (1997) that
with the new  millennium  which we have recently  entered, a new public  health  is needed  and  that in
order to achieve it we have,

to review and renovate the mandate, substance, and methods which will force  us to redraw
the traditional boundaries of public health, including its relationship with medicine and  the
social sciences.

Again as they note in the health transition occurring, new  patterns of morbidity and mortality  are
altering the agenda of international health. Among the emerging issues posing new challenges are the
importance  of mental  and behaviour  related  health  conditions  and  the  threat  of  sexually  transmitted
disease  and  death.  Indeed  they  underline  the  fact  that  it  was  HIV/AIDS  and  its  spread  that  was
probably  the single most important  factor  contributing  to the growing  acceptance  of  anthropological
perspectives  and  methods  for  public  health.  Other  major  issues  emerging  are  the  links  between
Public Health and Human Rights and Public Health and Poverty and  Inequality.

Any  understanding  of  epidemiological  patterns  -  any  efforts  to  improve  the  health  of
people showing  low health indicators -  must consider, and attempt to affect,  human  rights
and inequitable socio-political and economic conditions (ibid.) 

'

Meanwhile poverty  is pervasive and access to health services is limited.

Politics, Poverty and Health Development  in Africa

Professor  Francis  Nkrumah  has  recently  delivered  a  lecture  to  the  Annual  Meeting  of  the
American Society  of Tropical Medicine and Hygiene (Atlanta, November 2001)  which takes up this
last point. In his paper he looks at the current health and disease situation  in Africa  in the context  of
the  long  term  poverty  crisis  and  underdevelopment.  He  describes  how  in  pre-colonial  times  health
care mainly  consisted  of  traditional  medicine.  Decoctions  of natural  plant  products  were  used  and
the  knowledge  passed  on  from  generation  to  generation.  These  p;actices  still  persist.  The  western
based  health  care  system  came  with  colonialism  and  missionaries.  Ghana  and  other  independent
African  states  tried  to rapidly  replicate  medical  facilities  and  train  personnel.  However  these,  while
never adequate to reach the whole population, were severely  cut during the economic  squeeze  of the
1980s and the restructuring carried  out  in the  context  of Structural  Adjustment  Programs, in which
health and education specifically  were cut back, resulting in  escalating health crises.

At  the  same  time  the  region  has  a  large  share  of  the  global  disease  burden.  This  is  being
aggravated  by  the  changing  lifestyles  brought  about  b'y rapid  urbanization  and  moves  away  from
traditional  value  systems.  These  include  changing  sexual  behaviour  and  reproductive  practices
leading to sharp increases in new disease patterns and health challenges. In  1985 there was a regional
commitment  to  Primary  Health  Care  which  emphasized  community  based  health  and  related  inter
sectoral activities. In this the district assumes a pivotal role.

In Professor Nkrumah's words,

the  health  challenge  facing  African  societies  is  to  increase  the  ability  of  individuals,
households  and  communities  to reduce the suffering,  the  burden  of disease  and  premature
death at a much faster rate than in the past.

Meanwhile the struggle against underdevelopment  and poverty  remains of paramount  importance
the  over

and,  as  Professor  Nkrumah  stresses,  health  is  a  major  indicator  of  human  development, 
riding goal of whatever political, social and economic structures  are put in place.

The Agenda of the Seminar

The  agenda  of  the  seminar  was  a full  one  and  has  been  summarized  in a  report.  An  array  of
papers  were  presented  on  a variety  of significant  health  related  topics.  Throughout  the  participants
kept 
returning  to  the  consideration  of  culture—to  perceptions,  beliefs,  norms  and  to  changing
behavioural practices.  Ample opportunity  was  given  for  discussion  and debate and on  the last day
discussions  were  held 
in  small  groups  to  address  five  issues  in  more  depth.  As  well  as  social
scientists,  academics  and  public  health  and  medical  practitioners  and  administrators,  we  had
representatives  of  governmental  and  non-governmental  organizations.  Everybody  was  warmly
welcomed.  The  summary  of  the  proceedings  formed 
table
policy  and  research  discussion.  The  aim  was  to  stimulate  further  debate  among  policy  makers,
academics  and  donors  with  a  view  to  promoting  innovation  and  the development  of  successful
new  initiatives,  both  inside and  outside  the  university; in particular  to  promote  strengthening  of
fruitful  linkages  between  academia  and  other  governmental  and  non-governmental  institutions
concerned  with  the  socio-cultural  dimensions  of  Public  Health  in  Ghana.  Here  we  publish  a
selection of  papers from  the conference.  Several  more will be  edited for  publication  including  one
volume  focussing  on HIV/AIDS.

the  basis  for  a  subsequent  round 

Contents of This Volume

The papers  included  in this  volume  cover  an  array  of topics  dealt  with  in  the  seminar.  The
first  by  Brigid  Sackey  is  about  faith  healing  and women's  reproductive  health.  It  highlights  the
fact  that  spiritual  churches  in  Ghana  are  perceived  by  many  as  offering  remedies  for  witchcraft
based  afflictions  of reproductive  health.  It  stresses  the  need  to  take  a closer  look  at  the  beliefs
about  spiritual  causes  of  sickness  in  Ghana  and  how  to  educate  people  about  its  negative
impacts  on society.

The second paper, by A.K. Awedoba,  examines Kasena  Norms and  Reproductive  Health.  Kasena
reproductiove  culture  is  pro-natalist,  pro  child  and  pro  offspring.  The  third  paper  by  Douglas
Frimpong Nnuroh  discusses conjugal  morality as  perceived  by the Ellembelle  Nzema  of  Western
Ghana  and examines  actions  that  constitute  a  breach  of the  conjugal  code. These are  linked  to
concerns  about the  current  escalation  of sexually transmitted  death  in the  region.

The  fourth  essay  is by Clement  Ahiadike  and  examines  facts  concerning  the  incidence  of
self  induced  abortion  in Ghana and  the fifth  by Doris Essah  looks at Akwapim  school children and
their  needs  for  family 
life  education.  The  final  piece,  Dr.  Owusu's,  discusses  nutrition  and  its
important  links with  reproduction.

We  thank  UNFPA  for  its  financial  support  for  this  endeavour,  both  seminars  and  publications,
and  in particular express our  gratitude  to Mr Moses  Mukasa, the Country  Representative,  who  has
also  given  so  much  moral  support for this  joint  effort  between  the School  of Public Health and
the Institute  of African  Studies.

References

Heggenhougen  C. and D.  Pedersen,  1997.  Beyond  Quantitative  Measures:  the relevance  of  Anthropology  for
Public  Health,  Chapter  24  in the  Oxford  Textbook  of Public  Health  vol,  2  The Methods  of Public  Health
(eds.) R. Detels, W.W. Holland, J. McEwan & G. S. Omen. 3rd edition O:  ford  University Press.

Nkrumah  F.K.,  2001.  Politics,  Poverty  and  Health  Development  in  Africa.  Commemorative  Fund  Lecture

presented at the Annual Meeting of the American Society of Tropical  Medicine and Hygiene,  Atlanta.